The Department has many meeting forums through which it disseminates information and solicits feedback (see list of Committees, Boards, and Collaboration opportunities). In addition, the Department may convene a special interest meeting (or meetings) on specific policy topics that are outside the scope of those existing forums.

Through ongoing monitoring and evaluation, the Department ensures that Health First Colorado members receiving fee-for-service benefits have timely access to relevant and appropriate health care. The Department considers all levels of access issues, from single rate/procedure code access issues to geographic specific issues through to broader demographic access issues (such as access to care for LGBTQ+ members or for non-English speaking members). The Department also prepares access reports in line with federal access requirements.

The Department of Health Care Policy and Financing (Department) is committed to creating a high-performing, cost-effective system that delivers quality services and improves the health of Coloradans. The next iteration (Phase II) of the Accountable Care Collaborative (ACC) seeks to leverage the proven successes of Health First Colorado (Colorado's Medicaid Program) to enhance the member and provider experience.

Stakeholders and participants involved with this committee provide guidance and make recommendations to help improve health, access to care, cost and satisfaction of members and providers in the Accountable Care Collaborative (ACC). These committee meetings are open to the public.

The Adult Intellectual and Developmental Disabilities Waiver Redesign Stakeholder Group provides advice and consultation for the Office of Community Living's efforts to redesign its home and community based services waivers serving adults with intellectual and developmental disabilities.

The purpose of the Advocates Communication Meeting is to ensure ongoing, transparent, and collaborative communication between the Division for Intellectual and Developmental Disabilities and the advocacy stakeholders.

Health First Colorado (Colorado's Medicaid Program) established the Benefits Collaborative in 2008, in an effort to define its covered services. The Benefits Collaborative serves as the Department's formal coverage standard development process. Since the Benefits Collaborative aims to produce evidence-based policies guided by best practices, we seek to invite a diverse group of stakeholders - providers, administrators, members, advocates, policy makers, etc. into the process.

As part of the Department of Health Care Policy & Financing’s efforts to shift providers from volume to value, the Department is implementing a bundled payments program. This voluntary program is designed to incentivize providers to deliver the appropriate care at the right time. Under the proposed model, a provider who clinical experts have deemed as having the greatest ability to influence the episode is accountable for the success of the episode.

The Children's Disability Advisory Committee serves in an advisory capacity to the Department and makes recommendations regarding issues related to benefits for disabled children and youth age 20 and under, provider education interventions, and application of standards.

The Children's Services Steering Committee serves in an advisory capacity to the Department and makes recommendations regarding issues related to benefits for children and youth age 20 and under, provider education interventions and application of standards.

The primary function of this council is to provide guidance and recommendations regarding operational policy and procedural changes to the CCT program and to create solutions to streamline community transitions. The council will analyze barriers for transitions and provide recommendations for improved practices. Additionally, The CCT Advisory Council will provide recommendations for the use of rebalancing funds to the Department of Health Care Policy and Financing. In April 2019, this Council changed it's name to Transitions Stakeholder Advisory Council.

The Colorado Healthcare Affordability and Sustainability Enterprise Board is responsible for working with the Department of Health Care Policy and Financing and the Medical Services Board to develop the hospital provider fee model, monitor the implementation of the bill, help with preparation of annual reports on this program, and ensure that the Health First Colorado (Colorado's Medicaid Program) and Child Health Plan Plus (CHP+) eligibility expansions are implemented as intended.

Colorado's Long-Term Services and Supports Assessment and Support Plan

The Department of Health Care Policy and Financing, in collaboration with stakeholders, has developed new processes for eligibility determination, needs assessments, and support planning for all individuals seeking or receiving long-term services and supports. The new processes will be peson-centered, enhance self-direction, and facilitate greater coordination of services, as well as be equally applicable to adults with disabilities and children.

The Office of Community Living was created by Governor Hickenlooper through an Executive Order in July 2012. The Office helps meet the growing need for long-term services and supports by people with disabilities and aging adults and is housed in the Department of Health Care Policy and Financing (Department).

The Community Living Advisory Group worked from August 2012 to September 2014 to consider and recommend changes to the Long-term Services and Supports (LTSS) delivery system. The Advisory Group worked closely with the Colorado Commission on Aging and other planning groups to carry out this work and build on previous discussions and recommendations. The Advisory group finalized its work and issued its Final Report in September 2014.

The Colorado Department of Health Care Policy & Financing (HCPF) houses an advisory committee focused on quality improvement for HCPF’s Office of Community Living (OCL). The Community Living Quality Improvement Committee (CLQIC) provides input to the OCL on the development of a robust quality strategy from a person-centered perspective.

The Drug Utilization Review (DUR) Board serves in an advisory capacity to the Department and makes recommendations regarding issues of drug utilization, provider education interventions, and application of standards. The Board meets once quarterly. The Board consists of nine members appointed by the Executive Director; four physicians, four pharmacists licensed and actively practicing in Colorado, and one non-voting pharmaceutical industry representative.

The DUR Board also determines the prior authorization criteria for drugs with special prescribing guidelines and the prior authorization criteria for non-preferred drugs, those that don't make the Preferred Drug List (PDL).

The eHealth Commission was created to provide advice and guidance to the Office of eHealth Innovation on advancing Health IT in Colorado.

The Department of Health Care Policy and Financing (HCPF) serves as the fiscal agent leveraging the state’s procurement, contracting, and accounting established processes to manage solicitations, contracts, and payments to vendors and organizations on behalf of the new eHealth Innovation Office.

The 21st Century CURES Act, passed in December 2016, requires Medicaid programs to implement an Electronic Visit Verification (EVV) system for Personal Care and Home Health services. Per section 12006, all states must implement an EVV system to avoid a reduction in federal Medicaid funding, which could have a negative impact on Personal Care and Home Health services received by Health First Colorado members.

The purpose of this stakeholder meeting is to engage providers, members, and other stakeholders as the Department works to implement EVV for community based services offered through both the State Plan and Waivers.

As part of the Department’s efforts to shift providers from volume to value, the Department, along with stakeholders, has developed a payment model to make differential payments based on the provider’s performance. This payment model aims to give providers greater flexibility in care provided, reward performance, and maintain transparency and accountability in payments made. Under the proposed model, a portion of the Federally Qualified Health Center's Alternative Payment Methodology (APM) cost-based rates will be tied to quality activities and performance metrics. Progress within this framework not only encourages higher organizational performance but also helps the Accountable Care Collaborative (ACC) achieve its respective programmatic goals.

The federal Centers for Medicare and Medicaid Services (CMS) issued a final rule effective March 2014 to ensure that the provision of Home and Community Based Services (HCBS) occurs in settings that meet certain criteria. States have until March 2019 to ensure that their HCBS settings are compliant with the final rule which ensures that HCBS participants have access to the benefits of community living, and that services are true alternatives to those provided in an institutional setting and are delivered in the most integrated setting possible.

The Health Cost Analysis Task Force is the legislatively appointed body charged with selecting a nonpartisan, unbiased vendor to perform an analysis pursuant to House Bill 19-1176. The vendor will analyze the current health care system, a multi-payer universal system, a publicly financed and privately delivered universal system, or another system that would meet the health care needs of Coloradans.

Hospital Back-Up (HBU) is a program within Health First Colorado (Colorado's Medicaid Program) that supports qualified skilled nursing facilities in providing hospital level care to members who are ventilator dependent, have complex wounds, or have medically complex needs, as defined in rule 10 CCR 2505-10 8.470.1. The Hospital Back-Up Operational Process Improvement Workgroup has been developed to build on improvement recommendations identified by the University of Colorado's research of the HBU program.

In accordance with Senate Bill 19-005, the Department of Health Care Policy & Financing (Department) will be developing an application to the U.S. Department of Health and Human Services (HHS) to establish a Canadian prescription drug importation program.

The In-Home Support Services (IHSS) Subcommittee is a subcommittee of the Participant Directed Programs Policy Collaborative (PDPPC). The Workgroup includes IHSS stakeholders and is tasked with planning, implementation, and policy review for IHSS.

The Medical Services Board sets forth the rules that govern the Department's programs. The Board was established by law effective July 1, 1994 and consists of eleven members appointed by the Governor and confirmed by the Senate. Medical Services Board meetings are open to the public.

The Department has created a Member Experience (formerly Person- and Family-Centeredness) Advisory Council to help us integrate a person-and family-centered approach into Department business practices, policies and partnerships by engaging with Health First Colorado (Colorado's Medicaid Program) and Child Health Plan Plus (CHP+) members and family members/caretakers. There is an In-Person and a Virtual Advisory Council. Both serve as a way for members and their families/caretakers to work collaboratively with the Department to identify and implement person-centered practices, and create sustainable culture change in the Department.

The purpose of Nursing Facility Advisory Committee is to identify challenges in providing Health First Colorado (Colorado's Medicaid Program) services in nursing facilities. This committee provides an opportunity for Department staff, recipients, and providers to discuss issues unique to nursing facilities and their residents.

The Nursing Facility Provider Fee Advisory Board (PFAB) serves as a forum where the Department and stakeholder community can discuss the Nursing Facility Provider Fee program. The PFAB will explore alternative modeling options and approaches to improving and maintaining the program. The Board consists of community volunteer members who are familiar with the Nursing Facility Provider Fee program and reflect the diverse interests of the stakeholder community.

The Office of Community Living is working on a variety of policy and rule changes related to its Home and Community Based Services waivers and programs. The engagement of clients and stakeholders throughout these changes is a critical part of this process. This page provides information about a variety of projects.

The Participant-Directed Programs Policy Collaborative (PDPPC) is a stakeholder/Department meeting that replaced the Consumer-Directed Attendant Support Services (CDASS) Advisory Committee in January 2012. The PDPPC is a place where CDASS stakeholders and the Department work together, with transparency, on CDASS issues going forward.

The Pharmacy and Therapeutics (P&T) Committee performs clinical reviews of drug classes and makes recommendations which help the Department develop and manage the Medicaid Preferred Drug List (PDL). The P&T Committee is required to consider clinical criteria such as drug safety and efficacy when making its recommendations and considers public comments and testimony related to the drug classes being reviewed or other PDL-related agenda items.

As part of the Department of Health Care Policy & Financing’s (Department) efforts to shift providers from volume to value, the Department is developing a structure to make differential fee-for-service payments to give providers greater flexibility, reward performance while maintaining transparency and accountability, and create alignment across the delivery system. Under the proposed model, providers can earn higher reimbursement (when designated as meeting specific criteria) as they implement and achieve more advanced criteria. Movement along this framework not only encourages higher organizational performance but also helps the Accountable Care Collaborative (ACC) achieve its respective programmatic goals.

The Proposal for Affordable Health Coverage Option (HB 19-1004) requires the Department of Health Care Policy & Financing and the Division of Insurance to develop and submit a proposal to the General Assembly by November 15, 2019 concerning the design, costs, benefits, and implementation of a state option for health care coverage.

The purpose of the School Health Services (SHS) Stakeholder Forum is to provide an informal environment for the SHS Program participating providers and other stakeholders to exchange ideas, review policies and other pertinent information that relates to the SHS Program. The group can make recommendations to the Department for improvement and changes to the SHS Program that address processes and services.

The purpose of the Senate Bill (SB) 18-231 Transition Planning Task Force is to examine the problems that occur when children with intellectual and developmental disabilities and their parents experience difficulties in transitioning from receiving services in the educational setting to receiving services through the Department of Health Care Policy and Financing. The Task Force is charged with submitting a report by January 2, 2019, of its findings and recommendations to the Health and Human Services Committee of the Colorado Senate, the Public Health and Human Services Committee of the Colorado House of Representatives, and the Colorado Joint Budget Committee, or any successor committees. The Departments of Education and Health Care Policy and Financing are collaborating in the work of the Task Force.

Passed in 2019, Senate Bill (SB) 19-238 requires the Department of Health Care Policy and Financing (the Department) to request an 8.1% increase to the reimbursement rate for personal care and homemaker services. The bill establishes parameters through which home care agencies must pass through rate increases to personal care workers and report compliance to the Department. The bill sets an hourly minimum wage for personal care workers of $12.41 per hour effective July 1, 2020. Finally, the bill requires the Department to work collaboratively with the Department of Public Health and Environment (DPHE) and stakeholders to establish a process for reviewing and enforcing initial and ongoing training requirements for persons who provide covered services.

The purpose of this program is to promote the health and welfare of Colorado’s low-income seniors by providing access to dental care to individuals age 60 and over who are not eligible for dental services under any other dental health care program, such as Health First Colorado (Colorado's Medicaid Program).

The Colorado State Medical Assistance and Services Advisory Council exists to improve and maintain the quality of Health First Colorado (Colorado's Medicaid Program) by contributing specialized knowledge and experience and providing a two-way channel of communication with the individuals, organizations, and institutions in the community that provide medical care and services. State Medical Assistance and Services Advisory Council meetings are open to the public.

In accordance with House Bill 18-1136, the Department of Health Care Policy and Financing (Department) will be working to provide the full continuum of substance use disorder (SUD) benefits to Health First Colorado (Colorado’s Medicaid program) enrollees. The Department will be adding the inpatient and residential components, including withdrawal management, to the continuum of outpatient SUD services currently available. The Department’s objective is to make these services available for individuals who meet nationally-recognized evidence-based level of care criteria without shifting care from outpatient settings when they are more appropriate.

The purpose of the Telemedicine Workgroup is to gather key stakeholders to discuss development, expansion, and evaluation of telemedicine practices and policies across Colorado. Our quarterly meetings serve as a forum for sharing challenges and successes with implementing telemedicine, informing providers of benefit updates, and gathering feedback to generate policy change.

The primary function of this council is to provide guidance and recommendations regarding operational policy and procedural changes to the transition program and to create solutions to streamline community transitions. The council will analyze barriers for transitions and provide recommendations for improved practices.

Waiting Lists and Enrollment - Services for People with Intellectual and/or Developmental Disabilities

This page exists to provide and exchange information with members, stakeholders, providers, legislators, and policymakers about the Department's efforts to ensure qualified individuals recieve the services they need at the time they're needed, within the constraints of the state's limited financial resources.